| NPI | 1144057027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH BRYAN HOLTON Managing Partner 229-559-5944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2024-09-16 |
| Last Update Date | 2024-09-16 |